Posttraumatic Stress Disorder (cont.)

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

How is PTSD assessed?

For individuals who may be wondering if they should seek evaluation for PTSD by their medical or mental-health professional, self-tests may be useful. The National Institute of Mental Health offers a self-test for PTSD. The assessment of PTSD can be difficult for practitioners to make since sufferers often come to the professional's office complaining of symptoms other than anxiety associated with a traumatic experience. Those symptoms tend to include body symptoms (somatization), depression, or drug addiction. Studies of Iraq war veterans indicate that these individuals tend to show more physical symptoms of PTSD as opposed to describing the associated emotional problems.

Individuals with PTSD may present with a history of making suicide attempts. In addition to depression and substance-use disorders, the diagnosis of PTSD often co-occurs (is comorbid) with bipolar disorder (manic depression), eating disorders, and other anxiety disorders like obsessive compulsive disorder (OCD), panic disorder, social anxiety disorder, and generalized anxiety disorder.

Most health-care professionals who examine a child or teenager for PTSD will interview both the parent and the child, usually separately, in order to allow each party to speak freely. Interviewing the child in addition to the adults in his or her life is quite important given that while the child or adolescent's parent or guardian may have a unique perspective, there are naturally things the young person may be thinking, feeling, or doing that the adult is not aware of. Another challenge for diagnosing PTSD in children, particularly in younger children, is that they may express their symptoms differently from adults. For example, symptoms in children may include the child going backward or regressing in their development, becoming accident prone, engaging in risky behaviors, becoming clingy, or suffering from more physical complaints as compared to adults with PTSD. Traumatized younger children may also have trouble sitting still, focusing, or managing their impulses and therefore be mistaken as suffering from attention deficit hyperactivity disorder (ADHD).

Sometimes, professionals will use a rating scale or a structured psychiatric interview for children in its entirety or just the portion that assesses PTSD in order to test for PTSD. Examples of such tools include the Diagnostic Interview for Children and Adolescents-Revised (DICA-R), the Diagnostic Interview Schedule for Children-Version IV (DISC-IV), and the Schedule for Affective Disorders and Schizophrenia for School Age Children (K-SADS). There are also some PTSD-specific structured interviews, like the Clinician-Administered PTSD Scale-Child and Adolescent Version, the Child PTSD Checklist, and the Child PTSD Symptom Scale. For the assessment of the severity of PTSD symptoms in children, structured interviews like the Child Posttraumatic Stress Reaction Index, the Child and Adolescent Trauma Survey, and the Trauma Symptom Checklist for Children are sometimes used. The Child Trauma Screening Questionnaire has been found by some professionals to be useful in predicting which children who endure a traumatic event will go on to develop PTSD.